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Rapid, efficient detection and drug susceptibility testing of Mycobacterium tuberculosis in sputum by microscopic observation of broth cultures. The Tuberculosis Working Group in Peru.

Inexpensive, rapid, and reliable methods of detecting infection by and drug susceptibility of Mycobacterium tuberculosis (MTB) are crucial to the control of tuberculosis. The novel microscopic observation broth-drug susceptibility assay (MODS) detects early growth of MTB in liquid medium, allowing more timely diagnosis and drug susceptibility testing. Sputum samples from hospitalized patients in Peru were analyzed by using stains, culture, and PCR. Sensitivity of MODS (92%) compared favorably with the most sensitive of the other culture methods (93%). Sputum samples positive for tuberculosis were tested for susceptibility to isoniazid and rifampin with the microwell alamar blue assay (MABA) and MODS. In 89% of cases, there was concordance between MODS and MABA. Of the diagnostic and susceptibility testing methods used, MODS yielded results most rapidly (median, 9.0 and 9.5 days, respectively). MODS is a rapid, inexpensive, sensitive, and specific method for MTB detection and susceptibility testing; it is particularly appropriate for use in developing countries burdened by significant infection rates and increasing numbers of multiple-drug-resistant cases.

Antitubercular Agents↗

Distinctiveness of Mycobacterium tuberculosis genotypes from human immunodeficiency virus type 1-seropositive and -seronegative patients in Lima, Peru.

Genotypic analysis of Mycobacterium tuberculosis isolates obtained from human immunodeficiency virus type 1 (HIV-1)-seropositive (n = 80) and -seronegative (n = 25) patients from Lima, Peru, revealed two distinct genotypes correlating with the host immune status. While the level of intrastrain diversity of DNA fingerprints of HIV-seropositive isolates was less pronounced, these isolates showed many clonal groupings.

AIDS-Related Opportunistic Infections↗

Ecology of Helicobacter pylori in Peru: infection rates in coastal, high altitude, and jungle communities. The Gastrointestinal Physiology Working Group of the Cayetano Heredia and the Johns Hopkins University.

We have examined endoscopic clinic patients in three widely different geographic regions of Peru (the coast, the Sierra of the Andes Mountains, and the Amazon jungle) for the presence of Helicobacter pylori infection associated with active gastritis. The overall rates of infection were high (80% or greater) in all three zones and rates for men were approximately 10% higher than for women in the same zone. Men and women in the Sierra and jungle areas had significantly higher rates of infection than did those on the coast. There was no significant difference between the three populations with respect to the relationship between infection and grade of gastritis.

Adolescent↗

Community variations in infant and child mortality in Peru.

Data from the national Peru Fertility Survey are used to estimate infant and childhood mortality ratios, 1968--77, for 124 Peruvian communities, ranging from small Indian hamlets in the Andes to larger cities on the Pacific coast. Significant mortality variations are found: mortality is inversely related to community population size and is higher in the mountains than in the jungle or coast. Multivariate analysis is then used to assess the influence of community population size, average female education, medical facilities, and altitude on community mortality. Finally, this study concludes that large-scale sample surveys, which include maternal birth history, add useful data for epidemiological studies of childhood mortality.

Altitude↗

Monitoring trends in sexual behaviour and HIV/STIs in Peru: are available data sufficient?

OBJECTIVES: To review and summarise various types of Peruvian evidence on sexual behaviour, HIV/STI exposure and risk, and discuss how to increase its usefulness for HIV/STI risk trend monitoring in Peru. METHODS: Review HIV sentinel surveillance conducted by the Ministry of Health; data from the Demographic and Health Surveys (DHS); and academic publications on sexual behaviour in combination with biological markers. Changes over time, quality of data, size of studies, and intended audience are discussed. RESULTS: Data from HIV sentinel surveillance showed very high (8-23%) HIV seroprevalence among men having sex with men, but stable, relatively low figures among female sex workers (1%) and antenatal clinic patients (under 0.5%). DHS data suggest that single women increased their sexual activity throughout the 1990s but did not raise their contraceptive use accordingly, resulting in increased early conceptions. The contribution of condoms to overall contraceptive protection increased threefold in 1992-2000. According to the 1996 survey, men become sexually active 2.5 years earlier than women, but marry or cohabit four years later than women; women marry or cohabit 1.5-2.5 years after first sex, whereas men take eight years to do so. Finally, published studies confirmed dramatic differences in HIV prevalence between men who have sex with men and other populations, and also suggested patterns of bridging from men to women. CONCLUSIONS: Data available from the three sources are numerous, although limitations of each approach reduce their monitoring utility: Ministry of Health studies should select better sentinel populations and timely process behavioural data. Future demographic surveys should incorporate an AIDS risk perspective and include men.

Adolescent↗

Sexually transmitted and reproductive tract infections in symptomatic clients of pharmacies in Lima, Peru.

OBJECTIVE: To determine prevalences and predictors of sexually transmitted and reproductive tract infections among men and women seeking care at pharmacies. METHODS: Men and women with urethral discharge or dysuria and vaginal discharge were enrolled at 12 central and 52 smaller pharmacies in Lima, Peru. All participants answered a questionnaire. Men provided urine for polymerase chain reaction (PCR) testing for Neisseria gonorrhoeae and Chlamydia trachomatis, and for leucocyte esterase testing. Women provided self-obtained vaginal swabs for PCR testing for N gonorrhoeae and C trachomatis, Trichomonas vaginalis culture and bacterial vaginosis and Candida. RESULTS: Among 106 symptomatic men, N gonorrhoeae and C trachomatis were detected in 34% and were associated with urethral discharge compared with dysuria only (odds ratio (OR) 4.3, p = 0.003), positive urine leucocyte esterase testing (OR 7.4, p = 0.009), less education (OR 5.5, p = 0.03), and with symptoms for <5 days (OR 2.5, p = 0.03). Among 121 symptomatic women, 39% had bacterial vaginosis or T vaginalis, and 7.7% had candidiasis. N gonorrhoeae and C trachomatis were detected in 12.4% of the women. Overall, 48.8% had one or more of these infections. No factors were associated with vaginal infection, and only symptoms of vaginal discharge for <5 days were associated with N gonorrhoeae and C trachomatis (OR 4.0, p = 0.02). The main reason reported for seeking advice at pharmacies by both men and women was trust in pharmacy workers. CONCLUSIONS: Among men and women presenting to pharmacies with urethral and vaginal symptoms, rates of urethral and vaginal infections were comparable to those found in other clinical settings. Pharmacies can contribute to the care and prevention of sexually transmitted infection in developing countries.

Adolescent↗

Strategic control of fasciolosis in the inter-Andean valley of Cajamarca, Peru.

Fasciolosis is recognised as a major problem in dairy cattle in Cajamarca, Peru. The infection has an annual cycle, with the major period of infection from January to March. A control programme, involving two doses of the fasciolicide triclabendazole aimed at reducing the passage of Fasciola hepatica eggs on to the pasture, together with the use of the molluscicide, niclosamide, was evaluated against traditional treatment programmes. The double treatment regimen did not significantly reduce the overall parasite burden, as measured by faecal egg counts, but did control the parasites to a level similar to that achieved by traditional programmes averaging 3-7 treatments per year. The cows' eosinophil counts and serum liver enzyme activities were significantly lower than in animals treated by the traditional programmes. The use of niclosamide in addition to the triclabendazole treatments gave no clear advantage, although there was a significant reduction in the number of intermediate host snails after the application of the molluscicide.

Animal Husbandry↗

[Validation of the PCR-based universal heteroduplex generator assay for identification of rifampicin-resistant and multiresistant Mycobacterium tuberculosis in Lima, Peru].

OBJECTIVE: To validate the polymerase chain reaction-based universal heteroduplex generator (PCR UHG-Rif) assay for identifying rifampin-resistant and multidrug-resistant (MDR, resistant to isoniazid and rifampin) Mycobacterium tuberculosis in patients with pulmonary tuberculosis from communities in Lima (Peru) with a high incidence of resistant tuberculosis. DESIGN: To compare the results of antituberculosis drug susceptibility testing in clinical samples performed by the proportion method with those obtained by the PCR UHG-Rif assay, with the aim of analyzing the diagnostic capability of PCR UHG-Rif. RESULTS: Concordance for the identification of antituberculosis drug susceptibility was 0.95 (kappa = 0.899; P < .05), with a sensitivity and specificity of 0.973 and 0.922 (P < .05), respectively. The positive predictive value was 0.939 (95% CI: 0.879-0.970) and the negative predictive value was 0.965 (95% CI: 0.902-0.988). Nevertheless, the probability for MDR prediction was 0.981 (P < .05). PCR UHG-Rif allows the detection of mixed populations; discordant results can be explained by the presence of point mutations, missense mutations and mutations outside the rpoB "hot" region associated with rifampin-resistance. CONCLUSIONS: The PCR UHG-Rif assay detects mutations in the rpoB gene with excellent sensitivity and specificity, and suitable predictive values when compared with the standard method for determining susceptibility to antituberculosis drugs. This test can be considered an excellent tool that can contribute to tuberculosis control by correctly identifying patients infected with resistant and MDR bacilli, leading to a reduction in the cases of tuberculosis and resistant tuberculosis.

Antibiotics, Antitubercular↗

Genetic diversity in an Andean population from Peru and regional migration patterns of Amerindians in South America: data from Y chromosome and mitochondrial DNA.

The genetic variability of a Quechua-speaking Andean population from Peru was examined on the basis of four Y chromosome markers and restriction sites that define the Amerindian mitochondrial DNA (mtDNA) haplogroups. Forty-nine out of 52 (90.4%) individuals had mtDNA which belonged to one of the four common Amerindian haplogroups, with 54% of the samples belonging to haplogroup B. Among 25 males, 12 had an Amerindian Y chromosome, which exists as four haplotypes defined on the basis of the DYS287, DYS199, DYS392 and DYS19 markers, three of which are shared by Amazonian Amerindians. Thus, there is a clear directionality of marriages, with an estimated genetic admixture with non-Amerindians that is 9 times lower for mtDNA than for Y chromosome DNA. The comparison of mtDNA of Andean Amerindians with that of people from other regions of South America in a total of 1,086 individuals demonstrates a geographical pattern, with a decreasing frequency of A and C haplotypes and increasing frequency of the D haplotype from the north of the Amazon River to the south of the Amazon River, reaching the lowest and the highest frequencies, respectively, in the more southern populations of Chile and Argentina. Conversely, the highest and lowest frequencies of the haplogroup B are found, respectively, in the Andean and the North Amazon regions, and it is absent from some southern populations, suggesting that haplotypes A, C and D, and haplotype B may have been dispersed by two different migratory routes within the continent.

DNA, Mitochondrial↗

Clinicopathologic correlations in lupus nephritis in Lima, Peru.

BACKGROUND: We assessed whether immunohistologic markers for glomerular or tubulointerstitial injury might provide better correlations with ongoing renal function and disease activity as compared with the WHO classification or the NIH activity and chronicity indices in lupus nephritis. METHODS: Thirty-three patients with clinically defined systemic lupus underwent renal biopsy over a 1-year period at Hospital Loayza in Lima, Peru. Biopsy specimens were evaluated for macrophages, proliferating cells, alpha-actin expression, and type IV collagen deposition in both glomeruli and the tubulointerstitium and the results compared with the current WHO and NIH classifications in relation to the clinical presentation. RESULTS: Patients with WHO class IV lupus nephritis were more likely to have lower serum complements, greater proteinuria and hematuria, and worse renal function. An elevated NIH activity index correlated with microhematuria, proteinuria, and impaired renal function, whereas an elevated chronicity index correlated with renal function, hypertension, and microhematuria, but not with proteinuria. The presence of glomerular macrophages correlated with both glomerular alpha-actin expression and type IV collagen deposition, but did not correlate with renal function or proteinuria. In contrast, interstitial macrophages correlated not only with interstitial collagen deposition and myofibroblast accumulation, but also correlated with both renal function and the presence of nephrotic syndrome. CONCLUSIONS: Both the WHO classification and the NIH activity/chronicity indices correlate with clinical manifestations of lupus nephritis. While glomerular macrophage accumulation correlates with mesangial cell activation (alpha-actin expression) and collagen deposition, and interstitial macrophage accumulation correlates with interstitial fibroblast activation and collagen deposition, only interstitial macrophages correlate with renal function. Of particular interest will be future studies to determine whether these markers correlate with the prognosis.

Actins↗

Home range, activity pattern, and agonistic encounters of a group of night monkeys (Aotus trivirgatus) in Peru.

Findings are presented from a 9-week field study on Aotus trivirgatus in continuous primary, tropical forest in Peru. One group of 2 adults and 2 juveniles utilized the same lodge area in the center of a home range of 3.1 ha for the duration of the study. The group utilized eleven fruit trees of nine different species during the 9 weeks. The home range overlapped extensively with that of other Aotus groups.

Aggression↗

External quality assurance for cervical cytology in developing countries. Experience in Peru and Nicaragua.

Given interest from the professionals concerned, an external quality assurance scheme for cervical cytology can successfully be introduced in developing countries. This is a very important precondition if screening programs are to be expanded and decreases in mortality from cervical cancer are to occur in developing countries. Nicaragua and Peru have been experimenting with an external quality assurance system adapted from the Scottish and Northern Ireland scheme. It has been received with enthusiasm and acceptance and has helped cytology laboratories in these countries focusing on quality issues. Nevertheless, a successful quality control scheme that is to result in improvements in the quality of professionals' diagnostic skills needs to be accompanied by a remedial program for subperformers.

Diagnostic Errors↗

Operational evaluation of treatment for tuberculosis. Results of a "standard" 12-month regimen in Peru.

To measure the operational effectiveness of treatment for tuberculosis in Peru was evaluated the outcome of a 12-month treatment regimen in 2,510 patients who had tuberculosis diagnosed in 1980. All patients had acid-fast bacilli detected by sputum microscopy and were to be treated with isoniazid, streptomycin, and thiacetazone daily for 2 months followed by either isoniazid and streptomycin twice a week or isoniazid and thiacetazone daily. Only 47% had a favorable outcome, 41% abandoned treatment, 6% failed treatment, 4% died, and 2% relapsed. Of 1,483 patients who completed treatment, 79% had a favorable outcome, whereas 21% had an unfavorable result (treatment failure, relapse, or death). These data indicate that failure to complete treatment is the major reason for the low rate of success but that, in addition, the effectiveness of the regimen in patients who complete treatment is not optimal.

Adolescent↗

Health and society in Amazonian Peru.

During his work in a jungle hospital of the Amazonian part of Peru, the author was able to study the health care delivery system in the area. He was impressed by its inadequacy, which seemed to be due less to medical, technological, and manpower deficiencies than to social and economic factors. An attempt is made to identify and classify these constraints. A systems view of the health care insufficiencies is outlined, showing how some barriers prevent the patient from making contact with the health system (input level), how others interfere with its working (processor level), while others limit the efficiency of its actions (output level). Finally, some measures for its improvement are considered.

Attitude to Health↗

Drug abuse treatment training in Peru. A social policy experiment.

A social policy experiment is presented that was conducted from 1997 to 2000 in a setting with a high level of readiness for implementing a randomized experiment of therapeutic community (TC) drug treatment training in Peru. Seventy-six drug abuse treatment organizations were randomly assigned into three groups, and data were collected at multiple assessment periods. Staff and directors in organizations assigned to the training groups participated in either 6-week basic training or 8-week basic plus booster training sessions, which were theoretically grounded. Small- to medium-size positive effects were found on increased staff empowerment to use actual tools and principles from the training; medium and large positive effects were found on the implementation of TC methods with fidelity after the training. A follow-up with the funding and training organizations 1 year later showed use of the evaluation results in decision making in both organizations.

Attitude of Health Personnel↗

[Fighting cholera in shanty-town. Successful experience of a Quebec project adapted to Peru].

Originally designed in Quebec, the MOI project was a collaboration between two professors of social work from Quebec and two members of the Peruvian NGO called SUR in Villa de Salvador, one of poorest slum areas on the outskirts of Lima. The approach is founded on the notion that the body is the primary instrument through which a person can interact with the world around him or her, and that the physical and mental health of an individual exists within the context of healthy conditions of life that must include at least a basic social and health infrastructure as well as healthy hygiene practices on the part of individuals, families and the local community. Preschool children (ages 4-6), study a different part of the body and its proper care each week through classroom observation games. Parents' help is requested to modify unhealthy conditions, at the same time to enrich the children's experience and to mobilize the community to improve health conditions. During the 1991 cholera epidemic, not a single case was counted in the experimental district, despite its clearly socio-economically impoverished status, and despite the fact that the Ministry of Health recorded 86,650 cases in the Lima-Callao district, accounting for about 40% of the total number of cases in the Peru. The prior work made it easier to explain how cholera is spread and what special new measures needed to be taken in addition to the hygiene habits already taught.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Traffic-related occupational exposures to PM2.5, CO, and VOCs in Trujillo, Peru.

A traffic-related exposure study was conducted among 58 workers (drivers, vendors, traffic police, and gas station attendants) and 10 office workers as controls in Trujillo, Peru, in July 2002. PM2.5 was collected, carbon monoxide (CO) was measured, volatile organic compounds (VOCs) were sampled and analyzed. Newspaper vendors had the highest full-shift CO exposures (mean +/- SD: 11.4 +/- 8.9 ppm), while office workers had the lowest (2.0 +/- 1.7 ppm). Bus drivers had the highest full-shift PM2.5 exposures (161 +/- 8.9 microg/m3), while gas station attendants (64 +/- 26.5 microg/m3) and office workers (65 +/- 8.5 microg/m3) were the lowest. Full-shift benzene/toluene/ethylbenzene/xylene exposures (BTEX) among gas station attendants (111/254/43/214 microg/m3) were much higher than those among van and taxi drivers. Several of the traffic-related occupational exposures studied were elevated and are of occupational health concern.

Air Pollutants, Occupational↗

Lead exposure and semen quality among traffic police in Arequipa, Peru.

This study examined lead exposure (n = 43) and semen quality (n = 18) among traffic police officers in Arequipa, Peru, where leaded gasoline is used. Blood lead (PbB) was measured using atomic absorption spectrophotometry, and semen was analyzed following World Health Organization (WHO) protocol. Mean PbB was 48.5 microg/dL. Although current PbB was associated with declines in several semen parameters (sperm morphology, concentration and total number of sperm), only sperm motility and viability differed significantly between the < or = 40 microg/dL and > 40 microg/dL categories, and decreased with increasing PbB in simple linear regression. Traffic police are an indicator group for excessive ambient lead exposure, and these results support earlier findings on the male reproductive toxicity of lead. The results should be interpreted cautiously since the numbers were small and the analysis was unable to control for all potential confounders due to incomplete data.

Adult↗